Arkansas's Opaque Algorithm to Allocate Health Care Excessively Cut Down Hours for Beneficiaries

In 2016, Arkansas replaced its human-based assessment system for allocating Medicaid home care hours with an algorithmic tool developed by InterRAI, a nonprofit coalition of health researchers. The algorithm analyzed about 60 health descriptions and symptoms to categorize people and determine care hours. Tammy Dobbs, who has cerebral palsy and previously received 56 hours per week of care, saw her hours cut to 32 per week without explanation. Hundreds of other program beneficiaries experienced similar dramatic reductions in care. Legal Aid of Arkansas filed a federal lawsuit in 2016 representing Bradley Ledgerwood and Ethel Jacobs, arguing the state failed to properly notify people about the change and provided no effective way to challenge decisions. During court proceedings, it was discovered that the algorithm contained multiple errors: the software vendor had mistakenly used a version that didn't account for diabetes issues, affecting about 19% of beneficiaries, and cerebral palsy wasn't properly coded, causing incorrect calculations for hundreds of people. The algorithm developer Brant Fries acknowledged the implementation was problematic, saying Arkansas officials didn't follow his recommendations for gradual transitions or grandfathering existing recipients. A federal judge ultimately ruled the state had insufficiently implemented the program, and Arkansas officials made some procedural changes while planning to migrate to a new system.